The Efficacy of a Facebook-delivered Physical Activity Counselling Intervention on Mental Health in Firefighters: a Randomized Controlled Trial

Background:

Posttraumatic stress disorder (PTSD) is characterized by a combination of emotional, behavioural, and physiological symptoms following exposure to a traumatic event. Due to a greater exposure to traumatic events, first responders such as firefighters tend to have worse general well-being, higher risk of problematic alcohol use, and worse sleep quality, which consequently results in mental health problems, and also increases the risk of firefighters of developing PTSD compared to the general population. Evidence-based guidelines for the treatment of PTSD consider psychotherapy and pharmacotherapy as first line treatment. However, less than 10% of first responders with PTSD seek these guideline-informed treatments. One of the reasons is that first responders have a unique culture of self-reliance and strength, where mental health issues are considered a weakness. A culture of not showing weakness, together with fear of stigma and of confidentiality breach are the main barriers for seeking traditional mental health treatment.

Physical activity (PA) and its structured form, exercise, are a non-stigmatizing, easily accessible and promising add-on prevention and treatment interventions for a wide range of mental disorders including depression, anxiety- and stress-related disorders. It has an effect size similar to commonly used pharmacotherapy in patients with anxiety disorders. Furthermore, PA-based interventions have shown to be effective in improving sleep quality and reducing alcohol consumption. Adding on the mental health benefits, PA-based interventions can also target the cardiometabolic co-morbidity commonly observed in people with depression, anxiety- and stress-related disorders and in first responders. Therefore, PA might be a promising treatment modality for physically inactive first responders with depression, anxiety, or stress symptoms. Current guidelines strongly recommend 150-300 minutes of moderate PA or 75-150 minutes of vigorous PA, or an equivalent combination of moderate-to-vigorous PA.

In order to successfully implement PA-based interventions as prevention and treatment programs, research should explore effective ways to deliver the intervention in a way that is appealing for the target population. E-health and new technologies could provide a novel and less stigmatising approach to mental health interventions. It is an accessible and low-cost tool that could be effective for delivering PA interventions, increasing PA levels and improving mental health outcomes in people with psychiatric disorders or mental distress. Social media, more specifically Facebook, is a promising platform that has been previously used for supporting PA interventions for people with severe mental illness. The use of a private Facebook group to deliver these interventions could increase the feeling of belongingness and facilitate peer-to-peer support.

Social support is an essential aspect of adherence to PA interventions. Furthermore, social and family support are well-known protective factors against mental distress after prolonged exposure to trauma. Recent research suggests that partners, family members, or friends (commonly known as "informal caregivers") of first responders with mental distress have poorer mental health compared with the general population. Moreover, informal caregivers are also more likely to be sedentary, defined as wake-time spent sitting, reclined, or lying down quietly, than the general population. Including informal caregivers as support partners in a PA intervention could be beneficial not only for the first responders, but for the health of their informal caregivers. Another relevant factor which has been found to impact implementation of PA in daily living is the quality of the motivation to engage in PA. Previous research has found evidence that higher levels of autonomous motivation are related to more leisure time spent in physical activity in firefighters. However, despite the calls for more research examining the mediating effect of autonomous motivation on PA-based interventions, there is still a lack of causal evidence on the influence of autonomous motivation on PA-related behaviour change in physically inactive firefighters.